Abdominal tuberculosis masquerading as carcinomatosis: Not difficult to miss!

Abstract

Introduction: Abdominal tuberculosis (ATB) is a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection. It usually presents with non-specific symptoms that can mimic other intra-abdominal conditions like acute appendicitis, Crohn’s disease, ovarian pathology, and intra-peritoneal carcinomatosis and is therefore, easy to overlook. Diagnosing ATB in the pediatrics population tends to be even more challenging as an obvious history of exposure may be difficult to obtain. Chronicity of symptoms and lack of Bacillus Calmette-Guerin (BCG) scar should raise suspicion. Diagnostic laparoscopic biopsy and histopathology provides definitive diagnosis. Case Report: This case report presents the case of a 16-year-old girl with a history of recurrent abdominal pain, vomiting, and pyrexia. At initial diagnostic laparoscopy, she underwent laparoscopic appendectomy. Vesicles were noted in the pelvis. The patient failed to improve. Exposure to tuberculosis (TB) was denied. Review of pre-operative computed tomography (CT), comprehensive re-laparoscopy, and histopathology of appendix were used for final diagnosis of this condition. The patient was treated using anti-TB therapy for six months following which, she was able to make a full recovery. Conclusion: Abdominal TB is very difficult to diagnose in young patients and should be considered in those presenting with vague, recurrent, or persistent abdominal symptoms. A high index of suspicion is needed for early diagnosis and prompt treatment of this condition. In patients with low or no identifiable risk factors for TB, definitive diagnosis is justified prior to the initiation of therapy.